Characteristics of Postoperative Atrial Fibrillation and the Effect of Posterior Pericardiotomy.

Abstract

BACKGROUND:

Postoperative atrial fibrillation (POAF) is a frequent complication of cardiac surgery. However, only a few detailed descriptions of the arrhythmia have been reported. We aim to describe the characteristics, outcomes, and variables associated with POAF and to evaluate how posterior pericardiotomy (PP) affects POAF characteristics.

METHODS:

In this post hoc analysis of the Posterior left pericardiotomy for the prevention of AtriaL fibrillation After Cardiac Surgery (PALACS) trial, we describe POAF characteristics based on continuous in-hospital telemetry data.

RESULTS:

Of 420 patients, 103 (24.5%) developed POAF. Median time to onset was 50.3 hours; 70.9% of events occurred within 3 days. Hemodynamic instability and rapid ventricular response occurred in 8.7% and 51.5% of cases, respectively. Most POAF patients received antiarrhythmics (97.1%), 22.3% electrical cardioversion, and 40.8% systemic anticoagulation. Median POAF duration was 24.0 hours; 70.9% of cases resolved within 36 hours. Median POAF burden was 15.9%. All patients were in sinus rhythm at follow-up. POAF was associated with longer hospitalization (7 vs 6 days; P < .001), but not increased mortality or morbidity. PP reduced POAF incidence (17.7% vs 31.3%; P = .001), especially after postoperative day 2 (time to POAF onset 41.9 vs 57.1 hours; P = .01). Age was associated with POAF. Female sex, coronary artery bypass grafting, beta blockers, and PP were inversely associated.

CONCLUSIONS:

POAF remains frequent after cardiac surgery. Hemodynamic instability is rare, although rapid ventricular response and need for electrical cardioversion are frequent. POAF burden is significant, and the arrhythmias resolve within 30 days. PP reduces POAF especially after postoperative day 2.

• Authors: Roberto Perezgrovas-Olaria, David Chadow, Christopher Lau, Mohamed Rahouma, Giovanni Jr Soletti, Gianmarco Cancelli, Lamia Harik, Arnaldo Dimagli, Lisa Q Rong, Marc Gillinov, Niv Ad, Michael DiMaio, Annetine C Gelijns, Tommaso Sanna, Stephen Fremes, Filippo Crea, Leonard Girardi, Mario Gaudino
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 116 Issue 3 Pg. 615-622 (09 2023) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 36375495 (Publication Type: Clinical Trial, Journal Article)
• Copyright: Copyright © 2023 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Topics

• Female
• Humans
• Atrial Fibrillation (epidemiology, etiology, prevention & control)
• Cardiac Surgical Procedures (adverse effects)
• Coronary Artery Bypass
• Pericardiectomy
• Postoperative Complications (epidemiology, prevention & control)
• Risk Factors
• Male